title: Evaluating the accuracy of electronic pediatric drug dosing rules.
abstract: OBJECTIVE
  To determine the accuracy of vendor-supplied dosing eRules for pediatric medication orders. Inaccurate or absent dosing rules can lead to high numbers of false alerts or undetected prescribing errors and may potentially compromise safety in this already vulnerable population.
  
  
  METHODS
  7 months of medication orders and alerts from a large pediatric hospital were analyzed. 30 medications were selected for study across 5 age ranges and 5 dosing parameters. The resulting 750 dosing rules from a commercial system formed the study corpus and were examined for accuracy against a gold standard created from traditional clinical resources.
  
  
  RESULTS
  Overall accuracy of the rules in the study corpus was 55.1% when the rules were transformed to fit a priori age ranges. Over a pediatric lifetime, the dosing rules were accurate an average of 57.6% of the days. Dosing rules pertaining to the newborn age range were as accurate as other age ranges on average, but exhibited more variability. Daily frequency dosing parameters showed more accuracy than total daily dose, single dose minimum, or single dose maximum.
  
  
  CONCLUSIONS
  The accuracy of a vendor-supplied set of dosing eRules is suboptimal when compared with traditional dosing sources, exposing a gap between dosing rules in commercial products and actual prescribing practices by pediatric care providers. More research on vendor-supplied eRules is warranted in order to understand the effects of these products on safe prescribing in children.
authors.affiliation: Department of Pediatrics, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Kirkendall
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Spooner
authors.forename: Judith R
authors.initials: JR
authors.lastname: Logan
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000592:standards; D012189:Retrospective Studies
chemical_list: D004364:Pharmaceutical Preparations
keywords: CPOE; Decision Support Systems, Clinical; Electronic Health Record; Electronic Medical Record; Medical Order Entry System; Medication Alert System